Cancer Care in Resource-Limited Countries: The KHCC Story

Name: Cancer Care in Resource-Limited Countries: The KHCC Story
Uploaded: 2023-03-23T16:13:26.8933333Z
Duration: 1 h 2 min 16 s
Description: HRH Princess Ghida Talal, Chairperson of the King Hussain Cancer Foundation and Center Dr. Asem Mansour, CEO and Director General Dr. Hikmat Abdel-Razeq, Deputy Director General, Chief Medical Officer, Chairman of the Department of Internal Medicine

March 23, 2023

HRH Princess Ghida Talal, Chairperson of the King Hussain Cancer Foundation and Center

Dr. Asem Mansour, CEO and Director General

Dr. Hikmat Abdel-Razeq, Deputy Director General, Chief Medical Officer, Chairman of the Department of Internal Medicine

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ID: 9722
To Cite: DCA Citation Guide

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00:0320 years since the establishment of the
00:06leading cancer centre in the Arab world.
00:1120 years of the best medical
00:14minds gathered under one roof.
00:1820 years celebration, strength,
00:23survival. And new beginnings.
00:29Bearing the name of Jordan's legendary
00:31leader, the King Hussein Council Centre
00:34was established by King Abdullah the
00:37second with a mission to provide the
00:39most advanced cancer care to every
00:42Jordanian and every Arab patient.
00:50Our internationally accredited
00:52center provides integrated
00:54space for patient care.
00:56Education and research.
00:58Our patient centered approach
01:01to cancer care is enabled by a
01:04highly qualified medical team.
01:09In state-of-the-art facilities
01:11which offer privacy and comfort.
01:17And an outdoor sanctuary to promote healing.
01:23Children at KC receive specialized
01:28attention in child friendly
01:30spaces dedicated to treatment,
01:32recreation and continuing education.
01:38HCC's Jewel in the crown,
01:40its own marrow transplantation program,
01:43is one of the largest in the Middle
01:45East and is able to perform 300
01:48procedures annually with success rates
01:52commensurate with international standards.
01:55Our center is equipped with the most
01:58advanced cancer care technology available,
02:00including a cutting edge
02:03robotic surgery system.
02:04The first of its kind in Jordan.
02:08And an innovative brain lab,
02:10which integrates the most
02:12sophisticated brain navigation
02:14system with advanced MRI technology.
02:18Our cell therapy and applied
02:20Genomics Lab delivers highly advanced
02:22personalized medicine through cellular,
02:24therapeutic and genomics based technologies.
02:28It is home to the only public umbilical
02:31cord stem cell bank and Jordan KC
02:34is certified as a teaching hospital
02:37for hundreds of medical students at
02:40Jordanian universities and our education
02:42and Training Academy has made the KC
02:45a regional hub for superior oncology.
02:48Learning through its academic offerings.
02:54KHC recognizes research and
02:56innovation as the future of the
02:59fight against cancer at both the
03:03individual and institutional levels.
03:05To advance these efforts across the region,
03:08we launched the King Hussein Award
03:11for Cancer Research in 2020.
03:15Our efforts have no boundaries.
03:22The King Hussein Cancer Foundation
03:25supports the treatment of thousands
03:28of underprivileged patients,
03:30including refugees,
03:31through our goodwill funds.
03:34Looking to the next 20 years,
03:36and to ensure that no one will be deprived
03:38of treatment due to lack of capacity,
03:41KHC is embarking on several
03:44groundbreaking expansion efforts.
03:46Satellite centres providing accessible
03:48care to patients across Jordan
03:51through the construction of a new
03:53centre in Akiba named in honor of His
03:56Majesty King Abdullah the second,
03:58a standalone pediatric center in Amman.
04:02And a new ambulatory care center with
04:06integrated research laboratories.
04:08This is our story,
04:10a Jordanian institution that
04:12has grown into a world class
04:15life saving Cancer Center.
04:20This is the legacy of King Hussein.
04:23This is the vision of King Abdullah the
04:27second. This is the pride of Jordan.
04:52Good afternoon, everyone.
04:53Thank you so much for coming.
04:55It's a real pleasure to have
04:58the King Hussein Cancer Center.
05:00Tell you the story that you just
05:02saw in this video on few minutes.
05:03This took more than 20 years of
05:05actually very hard work to build
05:07this amazing Cancer Center.
05:09It's really a success story in
05:11a part of the world that has
05:13limited resources and the center,
05:15as you will hear, provides.
05:18Essentially free care for almost all
05:21Jordanians and many refugees who come
05:23from the area to get care in in Jordan.
05:26So it's really a true pleasure
05:28today to have heroin.
05:30Royal Highness Princess Aida Talal,
05:33who is the chairperson of the King
05:35Hussein Cancer Center Foundation,
05:37who's going to tell us about the
05:39story of how the Cancer Center
05:41started to start at the beginning
05:43and how it grew over time,
05:44but also doctor Asim Mansour
05:47and Doctor Hekmat Abderrazak.
05:48Will tell us about the medical
05:51aspects and the research aspects
05:53of the Cancer Center story.
05:55So Her Royal Highness Princess Rita
05:57has a very long history in helping
06:01philanthropic efforts across the region
06:04really to get support for the Cancer Center.
06:07She actually has had a degree or
06:10has a degree in journalism and the
06:13grad and undergrad from Georgetown.
06:16So she's an outstanding speaker,
06:17as you will hear.
06:19Very shortly.
06:20And she has also lived the
06:22establishment of the King Hussein
06:25Cancer Award that you just heard about,
06:26which is I think probably the first
06:29big program in the Arab world for
06:32Cancer Research promotion as well as
06:34enhancing the ability of the Cancer
06:36Center to deliver care across the region.
06:39So it's really a true pleasure to
06:40have you and thank you so much
06:42for accepting our invitation.
06:54Good evening, everybody, or good afternoon.
06:57Thank you. Doctor Ahmed,
06:58I just have to correct you on one thing
07:01is that I graduated from the School
07:03of Foreign Service, not journalism,
07:05but I did work as a journalist later on,
07:09I'm, I'm really here to tell you about.
07:13Are part of the world about the story of
07:15a Cancer Center in our part of the world,
07:18in the developing world, and how we fight?
07:22Cancer. In the Middle East,
07:25how we fight cancer even though
07:29we are resource challenged.
07:31And we do a good job at it.
07:34So I first want to thank you,
07:38Doctor Zaidan,
07:39for your warm and generous welcome
07:42and for inviting me to join
07:44you for your grand rounds.
07:46I know that grand rounds at here
07:49are very prestigious and I'm very
07:51happy to be one of the speakers.
07:53So I'm also delighted to be here at Yale.
07:56Of course,
07:58this formidable institution that has
08:01shaped some of the greatest minds
08:04and produced 50 Nobel laureates,
08:07it's quite impressive.
08:09And I feel privileged to be with the
08:13dedicated leadership of the Yale Cancer
08:16Centre and the Medical Healthcare
08:18professionals to basically observe
08:20and attest to your life saving work.
08:24Work that has had an immense impact
08:27on the fight against cancer.
08:30Today I bring a story of success
08:35from my part of the world,
08:37from the Arab world, from Jordan.
08:4122 years ago I was tasked by King
08:45Abdullah the 2nd to establish the King
08:48Hussein Cancer Center and Foundation.
08:51KHC at a time when prospects.
08:55For cancer patients in our
08:57region were extremely bleak.
08:59There were no options for cancer
09:03treatment and adequate treatment
09:05was basically nonexistent.
09:07But as I speak to you today.
09:09Case C has transformed the landscape of
09:13cancer care in the Middle East region by
09:17providing the most advanced treatment,
09:19by leading regional research and
09:22by extending its care to Jordans
09:26refugee population at no cost.
09:29I'm certain that many of you know
09:32that Jordan has received the largest
09:36number of refugees with Turkey,
09:38about 1.5 million.
09:40Refugees are in Jordan.
09:46At Casey C, We also had to work
09:49hard to dispel the stigma that
09:52is associated with cancer.
09:55Basically, that the disease is
09:58an automatic death sentence.
10:00And when we began our Mission,
10:03Women's Health topped our priorities,
10:06as breast cancer has long been.
10:09A significant threat?
10:11So by conducting extensive early
10:14detection awareness campaigns,
10:16we succeeded in actually
10:19flipping the statistics.
10:21Reducing by half the percentage of women
10:24who get diagnosed at the late stages
10:27of their disease, from 70% to 35%.
10:31But we will not rest until.
10:36We'll get to the #0 where no
10:38woman has to die simply for not
10:42getting to treatment on time.
10:45Over the last 10 years,
10:46we have spearheaded Cancer Research
10:49in the Arab world as the only
10:52hope for a cancer free future.
10:55So in 2020,
10:57we launched an international
11:00research initiative,
11:01the King Hussein research,
11:03the King Hussein Award for Cancer Research,
11:07with the aim of empowering and
11:10recognizing the efforts of individuals
11:12and institutions pushing the boundaries
11:15of Cancer Research in the Arab world.
11:19And I'm proud that today,
11:2140 women at KHC are directly
11:25involved in scientific research.
11:27And it's also worth noting that
11:30nearly half of our center.
11:32And 47% of our positions are women.
11:38Throughout our journey,
11:40we developed strong and critical partnerships
11:43with international leaders in Cancer Care,
11:46chief amongst them Saint Jude
11:49Children's Research Hospital,
11:51MD Anderson Cancer Center and
11:54many others across the globe.
11:58Today,
11:58the King Hussein cancer patient
12:01treats about 6000 new patients
12:05annually and receives 350,000
12:08outpatient visits per year.
12:12We have so far treated in 21 years.
12:16Over 70,000 patients,
12:1870,000 patients who may have had
12:21nowhere to go at the King Hussein
12:24Cancer Center not been established.
12:27Among those are thousands of underprivileged
12:30patients from across the Arab world.
12:34From Palestine, from Iraq,
12:36from Syria, from Yemen,
12:39from Sudan, from Libya.
12:41Many of them are,
12:42of course,
12:43refugees and displaced people who have
12:46fled to Jordan to escape violence turmoil.
12:50And disintegrating healthcare
12:52systems in their countries.
12:56The treatment of these refugees.
12:59Is made possible by KHC's goodwill funds.
13:03Which support our most generous patients,
13:07most vulnerable patients who would
13:10otherwise remain untreated.
13:13To date,
13:14KCC has funded the treatment
13:17of nearly 5000 underprivileged
13:19patients at a cost of 150 million.
13:25But we cannot shoulder the burden alone.
13:29The support of the international
13:32community has been insufficient
13:34in the face of the devastating
13:37tragedies that have hit our region.
13:39This is the reason I consistently call
13:43on all parties and donors to support.
13:47Our unrelenting efforts to treat
13:50displaced people facing cancer.
13:55Doctor zeydan. We are so proud that
13:59a son of Jordan achieved excellence
14:02in his field and specially at an
14:06institution as esteemed as year.
14:08We are grateful for your unwavering
14:11support of the King Hussein Cancer Centre
14:14and we look forward to continued mutual
14:18engagement between our two institutions.
14:23On behalf of my Jordanian colleagues,
14:26I would like to thank again.
14:29The leadership of the Yale Cancer Center.
14:32For their invitation and for the
14:35warm welcome. We look forward.
14:38To welcoming you all to Jordan,
14:41to our beautiful country.
14:43To witness first hand.
14:45The life saving work that takes
14:48place at the King Hussein
14:50Cancer Center on a daily basis.
14:52Thank you.
15:03Thank you so much, Your Highness,
15:04for those introductory remarks.
15:05So now we are going to the main part
15:08of the presentation about the story
15:10of the King Hussein Cancer Center.
15:12Really, as I think as a very good example
15:15of how excellent cancer centers can be
15:17built in countries with limited resources,
15:20especially with cancer becoming
15:22a very global problem.
15:23I had the luck of having witnessed
15:26the progress of the Cancer Center
15:28in Jordan because I actually did a
15:31year before I came to the US in 2003.
15:33And I have seen the new highs that
15:35the Cancer Center keeps reaching to.
15:38So it's really a pleasure to
15:39have Doctor Hassan Mansour,
15:41who's CEO and the Director
15:43General of the Cancer Center,
15:45who will talk to us about the
15:47story of the Cancer Center.
15:48He's a renowned radiation oncologist,
15:50but importantly,
15:51he's actually a very creative writer.
15:54This is a book that he wrote
15:56during the Corona period,
15:58which actually was excellent in
15:59terms of like showing all the
16:02emotions that went through this.
16:03With,
16:04and I wanted to quote one quick
16:06paragraph from the preface of the
16:08book where he says that the duty
16:10of the cancer physician is not
16:12simply to prevent death or to try
16:14to roll the clock of time backwards,
16:16but to impress the patient and to
16:18help them find a new meaning to
16:19their life and to navigate the most
16:21difficult periods of their lives.
16:23So I think this really fully embodies
16:26what cancer care is truly about.
16:29And also we are privileged to
16:31have Doctor Hickman Abderrazak,
16:32who's the Chief Medical officer.
16:33And the deputy director who's also
16:35a very renowned global researcher in
16:37especially in breast cancer and both
16:39of them have done tremendously for
16:41the last 20 years to build the Cancer Center.
16:44Thank you so much for coming.
16:55Thank you, Amir. And
16:57good afternoon and thank you for
17:00giving us the opportunity to share
17:02our story story of Cancer Center
17:05working in a country with limited
17:07resources and as we all know cancer
17:12burden is increasing worldwide and
17:14given that it's management paradigm is
17:18associated with a tremendous financial,
17:22social and physical challenges,
17:24the developing countries are
17:26barely able to cope up with the.
17:28Increase, exponential, actually,
17:30increase in cancer services and
17:33the situation with our countries,
17:36with countries with limited
17:38resources is even worse.
17:40Not only for other factor about the
17:43differences between cancer care and
17:45countries with limited resources
17:47and more privileged countries,
17:49not only in the financial and
17:51economic factors,
17:52but also the geopolitical arena
17:54of the low and middle income
17:56countries is also different.
17:58This is why.
17:59Cancer care in countries with
18:01limited resources is also different.
18:03Jordan,
18:04like many other countries
18:06with limited resources,
18:07low and middle income countries is undergoing
18:11multiple transitions also all at once.
18:14And for all of these there are
18:17regional and countries specificities.
18:20There are also transitions in the
18:24epidemiological and demographic arenas
18:26and This is why cancer care in Jordan.
18:29Is a different and Despite that we have
18:33witnessed transition from communicable
18:36diseases from infectious diseases to NCD.
18:40But still infection is contributing
18:42to morbidity and mortality in
18:45countries with limited resources.
18:47This makes us facing double hits of two
18:50groups of diseases at the same time.
18:53Jordan is a small Arab country located in
18:57the eastern Mediterranean region with.
19:00The total land area of approximately
19:0390,000 square kilometres and a
19:06population of 10 million inhabitants
19:09and population annual growth rate of 2.5%.
19:12And despite the country is facing
19:16challenges in terms of lack of
19:18new urban natural resources,
19:21scarcity of water of oil,
19:23high unemployment rate,
19:25high rate of inflation but still Jordan
19:27is enjoying an excellent healthcare.
19:30And it's considered a hub for a
19:32treatment for different diseases,
19:34including cancer for the whole
19:37region about cancer.
19:39The Jordan Cancer Registry,
19:41the National Cancer Registry,
19:43was established in 1996.
19:45And since then,
19:46the number of new cases,
19:48cancer cases has doubled,
19:50reaching 7000 or more than
19:527000 cases among Jordanian.
19:54There are also 2500 other
19:56cases among Grand Jordina,
19:58and these are either refugees.
20:00For patients coming from other countries
20:03to Jordan for treatment and for a country
20:06which with high prevalence of smoking,
20:08it's not surprisingly that lung cancer is the
20:11most common cancer followed by colorectal,
20:13bladder,
20:14prostate leukemia in male and in females.
20:17As expected,
20:17breast cancer is the most common
20:20cancer followed by colorectal,
20:22thyroid and uterine cancer and
20:24you have to notice here that
20:26cancer like bladder cancer,
20:28leukemia and non Hodgkin's lymphoma.
20:30Are among the top five cancer in Jordan
20:34compared to the global data where none
20:36of them is existent and the top even 10.
20:40The other thing virus associated
20:42or cancers associated with
20:44viruses or caused by viruses are
20:46not highly prevalent in Jordan.
20:47If we take cervical cancer for example,
20:50we diagnose only 40 cases per year.
20:53This is due to low prevalence of HIV.
20:55The same applies to liver cancer,
20:58the hybrid cell carcinoma
20:59with diagnose only 70.
21:01Cases per year, which is less
21:03than 1% of all Jordanian cancers.
21:04This is not the case for all
21:06countries in the region.
21:08If we take Egypt for example,
21:10Egypt is not far away from Jordan,
21:11but liver cancer,
21:13carcinoma is #1 cancer in Egypt,
21:16due to high prevalence of hepatitis
21:19C heterogenic hepatitis C The
21:21Jordan population is young,
21:22but this is changing rapidly.
21:24We are moving now,
21:25like most of the countries in the region,
21:27from the expansive pattern
21:29of a population pyramid.
21:31So again constructive 180% of
21:34Jordanians now below the age of 45 and
21:37only 3.5% are above the age of 65.
21:40And as we all know age is the most
21:43common risk factor for developing
21:46cancer for pediatric malignancies.
21:48As expected,
21:49leukemia is the most common cancer
21:51followed by brain and CNS lymphoma
21:54and bone for this associated cancer,
21:56lung cancer is contributing to the
21:59highest percentage of death followed by.
22:01Colon cancer and breast cancer,
22:03and this is the case for most
22:05of our countries.
22:08When we speak about
22:09challenges we face while
22:11providing cancer care,
22:12we can group these those
22:14challenges into five groups.
22:15Challenges related to the medical
22:17services and infrastructure,
22:19to human resources, quality management,
22:21public awareness and financial burden.
22:24When we talk about the infrastructure,
22:26lack of connectivity and the fragmentation
22:28of care is a problem in Jordan where
22:31patients information is not moving
22:33between different providers and it's
22:34not uncommon for a Jordanian cancer
22:37patient to get diagnosed in one.
22:39This stage in another and treated in
22:413rd or even 4th centralization of
22:44services in big cities is a problem.
22:47Despite Jordan is a small country
22:49but with higher level of poverty
22:51and poor public transportation,
22:53this might contribute to delayed
22:55in cancer diagnosis and treatment.
22:58Lack of proper proper referral
22:59system is also problem where
23:01patient Jordanian patient when he
23:03or she diagnosed with cancer,
23:05they don't know from where
23:07to start and where.
23:09Google Human Resources is a global
23:11problem but has some specificity in a
23:13country well known for excellent human
23:16resources and healthcare and others.
23:18But we are situated in a sea
23:21of high income countries,
23:23oil rich gulf countries which attract our
23:26people to go there seeking a better income.
23:29Doctor Hickman in the second part of
23:32presentation will address this issue
23:34and how we overcame this problem,
23:36sustainability and consistency
23:37in a geopolitical.
23:39Uncertainty is a problem and the quality
23:41of care in Jordan and other similar
23:44countries is not equal among all providers.
23:47Also the primary Healthcare is weak.
23:51This is why we have to we have to jump
23:53in and to fill this gap as a Cancer
23:56Center and this imposed a tremendous
23:57pressure on us to fill the gap in awareness,
24:01early detection and long term
24:03follow up after treatment,
24:05although many of our countries are
24:07having a National Cancer registry.
24:09But those cancer registry are lacking
24:12outcome data and they are lacking a
24:15proper quality assurance mechanisms to
24:18ensure the quality and accuracy of data.
24:21This is why we established our center,
24:23our own hospital based cancer registry.
24:25We collect data,
24:26detailed data about each and every
24:28patient and we published this data.
24:30This is for our five year survival for breast
24:32cancer for example for colorectal cancer,
24:35for lung cancer and this is our
24:38acute lymphoblastic leukemia.
24:39Deatrick ones in comparison to the seers
24:42available data and you as you notice,
24:45both curves are superimposed
24:47indicating very comparable outcome.
24:50Public awareness and problem is
24:52problem in a country where tobacco
24:54is a public health emergency.
24:56As per WHO,
24:57Jordan is among the top three countries in
25:00the world in the prevalence of smoking,
25:0360% of Jordanian meals are smokers,
25:05one out of six boys are smokers
25:07and one out of 14 girls.
25:09Jordan and are also smokers and
25:1180% of Jordanians are exposed
25:14to second hand smoking.
25:16Again diagnosed,
25:17it's been diagnosed at a later stage.
25:20Here what we have witnessed some
25:22improvement in that as aerial
25:23Highness mentioned in breast cancer.
25:25But still this is way we been
25:28far away from
25:29we wish to see our patient with
25:32cancer diagnosed with stage.
25:34If we go to the National Cancer Registry
25:36it will not help us because as you notice
25:39most of the diseases are not steered,
25:42are not reported. Again we went
25:43back to our own Cancer registry,
25:46hospital based cancer registry.
25:47Again cancer is diagnosed at its.
25:50Yeah, this is for colorectal
25:51cancer for example,
25:52more than 75% are they ignored at
25:54stage three and four for lung cancer,
25:57it's even worse where 70% of our
26:00lung cancer patients are diagnosed
26:01at stage four with metastases.
26:04Already Jordan and other countries
26:07from the region have moved
26:10into westernized and lifestyle.
26:13This is why there is high
26:15prevalence of obesity where almost
26:1868% of Jordanians and many.
26:20Countries in the region have
26:22been mass index above 30,
26:25the same with the physical
26:27activity or inactivity.
26:28There is also lack of integration
26:30of supportive services.
26:31Actually it's not available
26:33most of the institutions.
26:34Here.
26:34C is the only institution in
26:36Jordan where the comprehensive
26:38palliative and home care with the
26:41comprehensive psychosocial and
26:42spiritual services and survivorship
26:44of cancer living support system
26:47and finally the financial burden,
26:49financial toxicity.
26:50This is a problem everywhere.
26:53Jordan spent 80% of its GDP on health,
26:56but still we spend mainly on treatment,
26:59not on prevention or early detection.
27:01And this is the problem,
27:02the second problem that most of what
27:05we spend is been spent on people
27:09with NCD's with chronic diseases.
27:12Again,
27:13financial building has aggravated
27:14by several factors including
27:16late stage at diagnosis,
27:18younger population than we have,
27:20longer follow-up,
27:21overtreatment in the absence of clinical
27:24practice guidelines and protocols,
27:26there is tremendous waste along the
27:28supply chain and refugees as Her
27:31Royal Highness mentioned as problem.
27:33This is why we formed our goodwill
27:35funds as Herald Highness mentioned
27:37and we spent before COVID 150 thirty
27:40five million U.S. dollars now.
27:42Herald Harness updated this number
27:44that we spent 150 as the million U.S.
27:47dollars on refugees and underprivileged.
27:50Jordan is a home for the largest
27:53refugee population,
27:541.5 million of them Syrians and 1.5
27:58million from other nationality over time,
28:00and this trend unfortunately
28:02will continue to rise.
28:04Doctor Hickman and his group
28:06published the Disparity and Cancer
28:09Care and access to Cancer Care
28:11among Syrian population.
28:13Breast cancer Syrian refugees and
28:16only 35% of those qualified for
28:19to have breast reconstruction
28:20had breast reconstruction.
28:22For radiation Oncology is a bit better
28:24because this is outpatient service,
28:26but still 77%.
28:28But for targeted therapy.
28:30Only 1/3 of women eligible for
28:33anti herto therapy or CDK 46
28:36inhibitors get this treatment.
28:39And genetic counseling ordered
28:4112% of genetic counseling.
28:43This has translated into another
28:45study published by the same group
28:47to comparing overall and disease
28:48specific survival for breast
28:50cancer between Jordanians and
28:51refugees and due to late diagnosis
28:54and poor access to care,
28:56there is much more or better
28:59survival among Jordanians
29:01comparing to the non Jordanians.
29:03Our story as OKC,
29:05as Harry Hines mentioned,
29:06the center was established 1991
29:09as a comprehensive Cancer Center.
29:12We signed an agreement with the National
29:14Cancer Institute of the USA and then
29:17we started our journey to transform
29:19our center into a world class center.
29:22We realized early that we should
29:24have strong governance and our
29:26governance is board of trustees,
29:28chaired by Her Royal Highness
29:29Princess Rita Palal,
29:30under which we have the foundation
29:32which is responsible for fundraising.
29:34To fulfill to help us fulfilling our mission
29:37and the center which is the medical arm.
29:39Both the center and the foundation
29:41are working on awareness and advocacy.
29:44The center has major expansion in 2017.
29:48Now we have 350 bids with the
29:51state-of-the-art or arts linear accelerators.
29:54We have 16 accelerators.
29:55Now we are expanding to have two more.
29:57One of them is Mr.
29:58Linac.
29:59We have state-of-the-art diagnostic
30:00and treatment tools to help
30:03us fulfilling our mission.
30:04To provide people of Jordan and the
30:07region with the best available cancer
30:09here we also incorporated supportive service.
30:12Before the era of KFC this supportive
30:15care services did not exist.
30:17We have the psychosocial pain management,
30:19physical therapy and nutritional services,
30:22patient support groups.
30:24Those concepts were fierce
30:26introduce by King Frasier.
30:28This has translated in huge number
30:31of patients we treat as heroines
30:33mentioned 6000 in new cases.
30:3575% are Jordanian and 25 from
30:38all over the Arab world.
30:40Accreditation and the quality of
30:42care was very important to us.
30:43We were the first institution to get
30:46Joint Commission accreditation in 2006.
30:50A year later,
30:51we were the first center outside
30:53the US to get disease specific
30:55accreditation as a Cancer Center.
30:57We are proud that in 2019 we get the
31:01magnet award for Excellence and Nursing care.
31:04In the same year,
31:06our human protection program
31:08got the AHAR accreditation.
31:10The importance of international collaboration
31:12was mentioned by Her Royal Highness.
31:15This is very important.
31:16This is why we built a strong
31:18network of collaborations.
31:20And the international,
31:22regional and national levels.
31:26Councillor control in the country
31:29with many high risk to develop
31:31NCD's is very important.
31:33Our Cancer Control Office is involved
31:36in understanding and managing
31:37risk factors and mainly we are
31:40dealing with tobacco as a priority.
31:42We brought to the Jordanian literature
31:44for the first time an Atlas of the
31:48status of Tobacco and Jordan and
31:50the Arab world early detection.
31:52We started with breast cancer,
31:54as Her Royal Highness mentioned.
31:55Now we embarked on.
31:58Research project on lung screening
32:00for lung and colorectal cancer
32:03in high risk population and we.
32:06Anticipate that by the end of this
32:09year we will have the result about
32:12the feasibility of performing
32:14these interventions.
32:16Clinical services,
32:17we have a horizontal organizational
32:20structure around services,
32:23multidisciplinary services covering
32:24all disease side and we mandate
32:27that we have unified treatment
32:29approach and in-house pathology
32:31and radiology review for all cases.
32:33And we mandate that each service
32:35has process and outcome indicators
32:37also established in each programs.
32:40A representation of it is our bone
32:42marrow transplant which is the largest
32:44and most advanced in the region.
32:46Was established in 2003 with the
32:48simple procedures and nowadays we
32:51perform each procedure one more
32:53transplant procedure and actually now
32:55in the plan we are in the planning
32:57phase to establish our Carticel in
33:00collaboration with Mayo Clinic and
33:03Saint Jude for pediatric patients.
33:06This is some of our data on
33:08bone marrow transplant.
33:09We treat all ranges of age ranges.
33:11We treat Pediatrics and adult.
33:13We do allogenic and autologous transplant.
33:16And we do transplant for
33:19benign and malignant diseases.
33:21Expansion heroines mentioned about the Acaba,
33:24a branch actually in the video that you was,
33:27but most importantly that we built
33:30a partnership with the Ministry of
33:32Health to operate a cancer facility
33:34in the largest public hospital in
33:36Jordan in the poorest part of Amen.
33:39And the amount was to allow Jordanians
33:42regardless of their socioeconomic
33:43class to have access to the same
33:46equality of cancer care in the first
33:49year of this collaboration we treated.
33:51800 new cancer patients according
33:54to our protocols and by our people.
33:57This is our accamma branch and
33:59this is our future.
34:00This is our pediatric
34:02Cancer Research hospital.
34:03On this,
34:03I will stop and I will give
34:05the floor to my colleague, Dr.
34:06Heckman to give the second part
34:08of the presentation, please.
34:17I think you're awesome.
34:18Yeah, well, my talk will be a focus
34:21on research and education and training
34:24and the the history of research
34:26really dates back to 2003 and 10
34:29when we kind of believe that we
34:32are really reaching up to clinical.
34:34So it's a time to to go to to
34:36research and obviously we have
34:38lots of the thoughts and research,
34:41but we all believe that research is
34:43a must even in low income countries
34:45and this is because we need to.
34:47To understand this trend and the risk
34:49factors in our particular reputations,
34:52so for example in 2020 there was a close
34:55to a 20 a million new cancer cases diagnosed.
34:58The anticipation is that 330,000,000
35:01early cases will be diagnosed in 2040
35:03and bulk of those cases is going to
35:06be from the low income countries.
35:08If you look at the slide there,
35:10you see that the 50% or more of the cancer
35:14burden in 2040 will be from Asia for example.
35:17Things will be much worse actually
35:19if you watch this slide and a poor
35:22country is likely the African ones.
35:24The percentage of incrementally over
35:27the breast cancer for example is
35:29going to go from 203,000 cases to 450,
35:32which is the increment of 125% and
35:36that's compared to only 65% increment
35:39in North America for example.
35:42And we also believe that the citizen
35:44must because we have to come up
35:46with an invention and innovation.
35:48In cancer care delivery and outcomes
35:50in order to reduce the cancer specific
35:54mortality,
35:54if you look at the data and anticipated
35:57data from North America,
35:59cancer deaths would increase by 45% in 20-40.
36:02But if you look at the African countries
36:05that percentage going to be exactly double.
36:08So the amount of requests are deaths will be
36:12reaching an epidemic in countries like ours.
36:15And did that also with the improve the
36:18quality of care for those the cancer
36:20patient and should we also inform
36:23and the cost of cancer delivery.
36:25This is the US city alone,
36:27it's anticipated that in in 20-30
36:30it close to $250 billion will be
36:34spent on cancer care alone.
36:36And this is the slightly arbitrary old
36:38from a 2020 before the introduction of
36:41lots of immunotherapy and courtisols.
36:43So anticipation is that they're much more.
36:45Then this numbers will be spent on
36:48cancer care in Western countries.
36:51And this is just because of the
36:52cost of the drugs.
36:53This is just an example.
36:54It's not unusual to be close
36:57to $100,000 before 1 cycle of
37:00chemo or immunotherapy nowadays.
37:01So it's being routine.
37:03And this slide would show you that
37:06today 20% of America for example,
37:08would be out of pocket to the
37:10core payment of $20,000 or more.
37:12This is in Westernized countries,
37:14just to illustrate to you that.
37:15How much of a cancer cost would be a
37:18problem in low income countries like ours?
37:21Yet today bulk of research related to
37:24cancer is done in the Western countries.
37:27The slide that we showed you
37:29that the only 8%
37:30of the clinical trials are conducted in
37:33low income countries that compared to
37:35a bit more than 90% industrialized ones
37:37and not only the quantity of research
37:40but also the priorities in yellow.
37:43This is the European priorities you see.
37:46Bulk of the research has been done and none
37:48NCD's and cancer and chronic illnesses.
37:51While in African countries in the blue
37:53you see bulk of those researchers
37:55are done and infectious diseases.
37:57So city both things a the quantity
37:59and B the quality and the priority
38:02of researchers are totally different.
38:05So these are the lots of challenges
38:07that we feel that we have to generate
38:11the country specifically evidence
38:13we have to have our own data to.
38:16Better have effective preventive
38:19programs and infections better access.
38:22And improve our survivorship and
38:25parity care programs.
38:26And when it comes to generating
38:28any cancer specific data,
38:29I feel the cancer genetics is the
38:31biggest example as illustrated by
38:33her real Highness Andre Awesome.
38:35This is really when we started.
38:37We think that reconciled genetics
38:38in our part of the world is a little
38:40bit different.
38:41This is the collaborative research
38:43within the Anderson that when we
38:46approve the concept that cancer genetics
38:49Rebecca is a lot higher in our country.
38:52Compared to what's being published and
38:54this is where we started retesting each
38:57and every eligible cancer patient.
38:59We have data now and over 6000
39:02patient tested for genuine mutation
39:04and to see the buttons.
39:06And this is where data was presented at
39:09San Antonio at ASCO and was published
39:12just two months ago illustrating
39:14that 14% of eligible Judean patient
39:16are having germinal mutation in one
39:19of those genes and specifically 50%
39:22that are back home.
39:23Like a two,
39:23but the other fifty in genes other
39:26than Braca one and Braca 2 likes being
39:29published in the Western literatures.
39:31So these are some of the challenges
39:33that we face with researchers.
39:35Countries specifically challenges
39:36institutional 1 investigator and
39:39patient related when it comes to
39:42countries specifically challenges we
39:44alive and lots of original conflict
39:47and instabilities.
39:48Counties in blue while we do have
39:51the active biological instabilities.
39:53Now when it comes to also countries
39:56that challenges,
39:56we have issues related to boluses procedure,
39:59regulatory framework related to
40:01genetic research issue, banking,
40:03material transfer and cancer registry
40:06and would come to cancer registry.
40:08It's extremely important to have the
40:10this city kind of data to better
40:13assess the cancer burden better do
40:16epidemiological studies,
40:17planning and evaluation of healthcare
40:19and it is the only source for rich.
40:23Areas where you can judge the
40:26feasibility of what's ongoing clinical
40:28trials.
40:29Unfortunately in reality you see here
40:32only 24% of low income countries do
40:35heavily cancer registries compared
40:36to close to 90% and westernized one.
40:39This is our journey at KSC establishing
40:42the Cancer Registry which was started
40:45in 2006 who was the 1st in the region
40:48at back then we used CDC softwares
40:51but nowadays we use the commercial.
40:54We have data of over
40:5765,003 cancer patients and that probably
40:59helping us deciding and feasibility of
41:02research and nowadays we do have cancer
41:05registry registrars and those are improving
41:07a lot in the quality of the data kept.
41:11We do have also institutional challenges
41:14when it comes to research infrastructure.
41:17It trained the human resources and lots of
41:19those who are trained enough would leave the
41:22country and difficult to recruit repack.
41:24We have also issues related to Grant
41:27Lee money accessory for a grant access
41:30for new drugs and obviously we have
41:32challenges related to visibility at
41:35global level at investigator levels.
41:37We have issues because the lots of us
41:40were not trained to be investigators.
41:42In medical schools and really we have also
41:46heavy clinical duties at the hospital.
41:48So to balance the clinical care versus
41:51research is always really an issue.
41:53Research protected time is not
41:55existing in our part of the world.
41:57We just started that at KC also incentives
42:01would accelerated required progression
42:03be an enough incentive for a researcher
42:07or should be top that and salary and
42:10financial incentive to medical writing.
42:12Then issue also in countries where
42:14English is not the native language
42:16when it comes to vacation to the I
42:19intentionally kept the slide empty
42:20because we have not really felt
42:22that patient really is different.
42:24So we have no challenges when we approach
42:27patient to be recruited into clinical trials.
42:30So patient are the best example where
42:32all of them would love to go into
42:35a clinical trial to get accessory
42:37for new drugs and we feel that lead
42:40to enhance research we need to.
42:42Let's work with collaborator to
42:45promote knowledge sharing experience,
42:47easy access to funding and great
42:49visibility and opportunity to get
42:52access to drugs and technologies.
42:54And one of the best examples that
42:56in addition to what was mentioned
42:58about MD Anderson, St.
42:59Jude, we give up with RTC.
43:02This is the European Organization
43:04for Research and Treatment.
43:05We currently host the regional layers and
43:07Office for the whole Middle East regions.
43:10We participated in breast.
43:12GI worthy of care at almost all ERC groups,
43:17and this LED us to increase our
43:20publication if you zoom in as you see here.
43:23We published it last year close
43:26to 200 reviewers with reviews,
43:28case report,
43:29etcetera.
43:30And these are the cumulatively aggressive
43:33aggregated number of clinical trials,
43:35really close to 18 hours running at
43:38KFC and this is the King Hussein
43:41Award for Cancer Research,
43:42Princess Redemption.
43:43And these are the two years already
43:462021 and 2022 and this city,
43:49a third one will be upcoming this
43:52November there's an award for.
43:54Academic program excellence and
43:55another one for lifetime achievement.
43:58A third one for promising a researcher
44:00grant and a younger investigator.
44:02The four three award now it comes to
44:05training and education a few boards
44:07in order to keep the staff at KFC
44:10as mentioned we had the close to
44:12500 physicians over 1003 nursing
44:15150 pharmacist 3 many of them
44:18are clinical pharmacists and we have 1600
44:21the others but we face threepenny drain.
44:24Lots of those trained physicians
44:26would leave the country and
44:28difficult to to recruit it back.
44:29And This is why we built really
44:33strong academically affairs
44:34and academic affair programs.
44:36This is the GE offers the
44:38graduate Medical Education Office,
44:40we have the undergraduate medical
44:42education and is that sagram and
44:44transitional fellowship programs.
44:46We have also a training Academy for a
44:49structured and unstructured training program.
44:51We offer boosting graduate education.
44:53We offer massive.
44:54Three years and diplomas I will
44:56show you and we are affiliated with
44:59the largest university in Jordan,
45:01University of Jordan and this
45:02is the our residency program.
45:04We have only four year residency
45:06programs and additional cology,
45:07pathology, nuclear medicine etcetera.
45:09We also have the transitional residency
45:13programs and the big three programs in 10
45:16months and general surgery and Pediatrics,
45:19but also the strength and
45:21the fellowship programs.
45:22We have programs in medical oncology,
45:24surgical oncology.
45:25Yeah, they conchology etcetera,
45:27not even battery,
45:28but also we have KPI's,
45:30we participate in the US
45:32and in training exam,
45:34the surgery for medical oncology for example,
45:37where over 200 programs in North America
45:40participate with over 2000 detainees.
45:42All fellows in the states need to
45:45sit for the exams we start doing.
45:47So the last 10 years and
45:49over the last 10 years,
45:50we always rank among the
45:53best 3 institutions across.
45:55North America,
45:56so this is you just illustrate
45:58to you that the quality of the
46:00trainees that we have matched
46:01those in Western countries.
46:03However,
46:03this is the record of one of our
46:06trainees as illustrated she did
46:08perform in every aspect in a
46:11clinical and medical oncology but
46:13you see in yellow she significantly
46:15underperformed research which
46:16illustrate to you that research has
46:19not been addressed at medical schools
46:21and our both the world this is where
46:23we need to do lots of work in there.
46:26We offer master degree and cancer
46:28informatics in collaboration with
46:30Bristol and University of Jordan.
46:33We also offer diplomas and valuative care,
46:36respiratory therapy and their management.
46:38We also have a strong training
46:40program in pharmacy,
46:42the strong internship program,
46:44pharmacy residency,
46:45pharmacoeconomics and pharmacogenomics
46:47clinical training programs and
46:50also research right training for
46:53pharmacists nursing is not to the.
46:55Forgotten,
46:56we have also strong training
46:58program for nursing.
46:59This is an oncology nursing residency
47:02program which is accredited by the
47:04American Nursing Credentialing Center
47:06and to manage our branded drain and
47:09this is the paper republished three
47:12years Reback at GCO Global Ecology.
47:15We feel the strongest way to do it is
47:17to have a strong local training program
47:21accredited one with international
47:23collaboration with leaving.
47:26There's some flexibility for our
47:27guys to move around and this is
47:29the experience that we had with
47:31Prince Margaret Hospital where
47:32lots of our trainees spend a year
47:34or two over there getting trains
47:37and specifically areas.
47:38In conclusion,
47:39cancer burden in low income country is an
47:42ongoing and increasing problem vision
47:45still present with advanced stage
47:47disease and This is why we have to have
47:49a strong prevention and early detection
47:52programs in order to inform inaccurate.
47:56And the cost of treatment,
47:58country specific data and evidence
47:59are highly needed because we
48:01feel we are different from what's
48:03been published in the West.
48:04And the only way to do that
48:06is through research.
48:07We have to manage brain drain through
48:09a good training and education.
48:11The offices and centers and the
48:14Center of Excellence in low income
48:16country is doable and we've just
48:19showed you our own experience and
48:22international collaboration with
48:23institution like yours is a must.
48:26In order to get what we already
48:28have very achieved with this,
48:30I stop and they thank you so much.
48:43Thank you so much.
48:44Excellent presentations and I know we
48:46have also a lot of audience on zoom.
48:49So I encourage you, the goal of
48:51this visit actually is hopefully
48:52to establish ongoing collaboration.
48:54So whether you work on population science,
48:57translational research,
48:58clinical research, any kind of
49:00avenue of collaboration you think of,
49:02please e-mail me and I'm going to be
49:04happy to connect you with the right
49:06people at KC and hopefully we can get
49:09some good collaborations going to help
49:11help them move the field forward.
49:13So any questions for our speakers today?
49:17Yes, please.
49:18And if you just.
49:24Patient will mandate.
49:27The role of traditional.
49:31Today. So.
49:35Yeah, that.
49:40Can you repeat the question just
49:41for the zoom audience, please?
49:42Yeah. So the the question is about the Bing.
49:45Yeah, yeah, Arabic medicine is the old one.
49:48What is the rule of alternative
49:50medicine and traditional medicine in
49:52cancer care in countries like ours?
49:54Well, almost every other patient tree
49:56in Jordan and in our part of the
50:00world do take alternative medicine.
50:02We have republished some data about the
50:04use of alternative medicine, but however,
50:06very few believe in just taking it.
50:08And the medicine not going
50:10through chemo and immunotherapy,
50:11we face the very few occasionally
50:14a patient who would refuse and
50:16getting chemo and radio for example
50:19and go for alternative medicine.
50:21But the they go both the hand in
50:23hand but there there is a significant
50:25portion of our patient who use
50:27alternative medicine but in addition
50:29to chemo and other medications.
50:33Yeah, doctor Harris.
50:36Yeah, but obviously like the
50:38Real Highness stated,
50:39she just mentioned an example just
50:41before we entered the auditorium here
50:43about the vision to refuse to take any
50:45chemo ambition to the breast cancer.
50:47This is really a totally curable kind
50:49of a cancer and she would not agree
50:51to take chemo or immunotherapy until
50:53she had a very advanced stage disease
50:55where nothing would work but still
50:57face some of those but have to declare
50:59that the none of alternative medicine
51:01is as good as the OR even close to
51:04a chemo or immunotherapy nowadays.
51:07I really enjoyed the presentation.
51:08Thank you all for coming.
51:10I noticed in some of your data,
51:12especially lung cancer,
51:13the late stages of diagnosis,
51:14especially at a time when our
51:16best therapies are moving to
51:17the earlier stage disease.
51:19So I'm wondering what efforts
51:20you're doing for screening in
51:22your country and also of course
51:24the smoking rates being so high,
51:25what you're doing for smoking cessation?
51:28Yeah, we rank probably #1 or #2
51:31worldwide when it comes to smoking.
51:33So almost every other Jordanian
51:35to smoke a cigarette or earlier
51:37what we call the argilla.
51:38And this is becoming very common
51:40among the teens and the unfortunately
51:42among the college student today too.
51:45And when it comes to lung cancer,
51:46you're seeing close to 70% of
51:48the vision of lung cancer present
51:49to the stage four disease,
51:50which is the totally incurable and the
51:52cost of the treatment is extremely high.
51:55So to do that we just recently
51:57launched a study to.
51:58Screen, uh doing the low dose CT
52:00scans for those patients and the
52:02goal is to screen 1000 patients to
52:05see the feasibility knowing that
52:07when you do a low dose CT scan,
52:09lots of those patients being smokers
52:11would have any apology that you
52:13end up doing lots of procedures.
52:15So the feasibility and the cost is
52:17an issue where they enrolled the
52:19170 patient in the study as I was
52:22mentioned earlier today and we have
52:24not diagnosed a single lung cancer,
52:26but we managed to diagnose.
52:28Two renal cell carcinomas actually,
52:31but not not cancer.
52:32So hopefully with the study the feasibility,
52:35my gut feeling is not going to be
52:37feasible because lots of those Bishop
52:39would have abnormalities in the biases
52:41in society where everybody smokes.
52:44So that can be a problem,
52:45but we have to wait until we see the data.
52:49I I just want to tell you really
52:51from a layman's perspective,
52:52I mean what we have tried to do,
52:54we have a strong smoking cessation
52:56clinic at the King Hussein Cancer
52:59Center and it has proven effective.
53:01But unfortunately it's the psyche that is
53:04still not there and and we are fighting
53:08the decision makers because we are not
53:11being able to even if laws are passed,
53:14they're not implemented.
53:15There is a very strong law
53:17that that has been passed.
53:19In the Jordanian Parliament about
53:21not smoking in public places,
53:24which is the case in Europe,
53:26in Lebanon even where they smoke a lot,
53:28but in Jordan, it's not in force,
53:30it's the lawmakers themselves who break it.
53:33So unfortunately it's it's
53:36actually a tragedy.
53:37And I have to say that I'm full
53:41of shame about that because.
53:44We it's what what we have been
53:46able to do is a drop in the ocean
53:49and people are still convinced
53:51that it happened to this person.
53:54It's not happening to me it's
53:57they still think that and.
53:59We, we,
54:00we have tried and we will continue to try.
54:02I mean there is no point saying no
54:04and I'm sure ultimately we will,
54:06especially as cancer numbers start
54:09as cancer statistics start showing,
54:11but until now we have not been able to.
54:17Really convince the psyche?
54:19And to change the psyche of the Jordanian,
54:23it's it's it's crazy.
54:24We are #1 country.
54:26For smoke.
54:28No, well, we're
54:29certainly, you know we work
54:30very hard in this country.
54:31We're still at 1213% and
54:33that's with so much effort.
54:33So it is hard and there are
54:35some who will be intractable,
54:36but it sounds like you've got some
54:38cultural issues that you know
54:39certainly you need to deal with.
54:40But I will say there's one
54:42bright spot here and I would
54:43disagree with you that metastatic
54:44cancer and smokers is incurable.
54:46I just left our clinic where Scott Gettinger,
54:48he can show us 1213 year
54:51survivors on immunotherapy.
54:52So I would urge you to use the
54:54population then to do the more
54:56novel immunotherapy trials.
54:57Especially if you're under resource that
54:59would be a great opportunity to look
55:01at PD1 and PD1 inhibitors and combinations.
55:04And I know you're meeting with
55:05some of our clinical trials,
55:06people who here today we'd love
55:07to talk to you about, you know,
55:09some ideas we have because that,
55:10you know, we don't want people to smoke,
55:11but if they've already smoked and
55:12we can't do anything about it,
55:13I think the therapies will
55:14help some small percentage,
55:15but it's getting bigger.
55:17I guess so immunotherapy is changing
55:19the history of the cancer care.
55:20Obviously, we use the three
55:22advanced stage diseases. Obviously,
55:23we have to wait and see him properly.
55:25Data is very impressive.
55:26But when it comes to lung cancer
55:28immunotherapy, I totally agree.
55:30Yeah, I actually have one of those
55:32patients 10 years out of metastatic lung
55:35cancer and she developed CML chronic
55:37myeloid leukemia and I actually treated
55:39her and she has the CML is gone now,
55:41PCR able -, 4 years.
55:43So she's technically probably cured
55:45out of two incurable cancers.
55:46It's just amazing.
55:47Mirror but how to get these medications
55:49I guess to you know to to the
55:51rest of the world I think is the
55:53biggest challenge that Doctor Mehra.
55:56I really enjoyed the three presentations. As
55:59a breast cancer surgeon,
56:00I really enjoyed the talk about the having
56:04of the. Rates of
56:06late stage disease, do you think
56:08that's mostly due to awareness or
56:10screening and as you know in Jordan
56:12the average age of breast cancer is
56:13probably in the mid 40s while in the United
56:15States it's in the 60s, yeah.
56:18So do you think it's mostly from
56:20the screening aspect or is it from
56:21public awareness opportunity?
56:25Actually we we did two studies 10
56:27years apart for a CAP study about the
56:29attitude of Jordanian woman towards
56:31screening and there are several factors,
56:34a taboo is one of the of them.
56:36Access to care is another one.
56:38Affordability is 1/3 and the most
56:42common answer we get I don't want
56:45to know what what I'm having.
56:48So this is another one what we worked
56:50at the Jordan Breast Cancer program.
56:52We started with the awareness to break the.
56:55Stigma.
56:55Then we supplied the old Jordanian
56:58cities and even towns with Mammographers.
57:01Now it's covered those cities
57:04where we don't have mammography.
57:06We have our own mobile mammography is
57:09crossing Jordan to do mammography for
57:11underprivileged women, they feared.
57:13We trained 10s of Jordanian female
57:16technicians and radiologists
57:18to do mammography.
57:20When I started doing mammography more
57:22than 20 years ago, we were only two.
57:25You are just doing mammography nowadays.
57:27At King Hussein Cancer Center,
57:28we have 7 full-time female radiologists
57:31trained and certified to do breast imaging
57:34from mammography to breast MRI to MRI,
57:37guided biopsy, et cetera.
57:39So we are changing culture gradually,
57:42but I think we need time.
57:44Thank you.
57:49The issue is not only doing a mammogram,
57:51the problem is that the outside
57:53the city of Amman for example,
57:55you have to go beyond the limits mammogram
57:58second locally ultrasound remarries
57:59and biopsies and that's was an issue
58:02initially but now we trained lots of those.
58:04So in each facility you have now a
58:07place where you can have a biopsy.
58:10We have also early an accessory
58:12for advanced pathology to to reach
58:14out for those patients.
58:15Now it comes to the treatment and
58:17today I must say that the treatment
58:19that has been available for.
58:20Each and everything that you think about it
58:22best cancer is available for those patients.
58:24So it's never an issue about treatment,
58:27it just broadly for vision to go
58:28forward to do their mammography
58:30and to follow up on those.
58:32Here.
58:35It's Speaking of.
58:38And you know,
58:39we have used every method possible.
58:42There are nationwide campaigns and
58:45they have been very effective in in
58:48encouraging women to to have their
58:52mammogram and to be very aware of themselves.
58:54And one would be surprised actually
58:57that very often we found that women
59:00in the countryside were actually
59:03more responsive than in the city.
59:06So, so everything.
59:07Together, hopefully we'll make a dent,
59:10but we we've moved a lot.
59:12Like I said,
59:13we we literally flipped the statistics.
59:1670% of our women were coming at the late
59:19stages and now it's only 35%, which is great.
59:22Not enough, but it's great.
59:25Yeah.
59:25Another example is the cancer genetics.
59:27Today we face no difficulties convincing
59:29the younger females to testify for a
59:32bracket and to do also cascaded testings.
59:34The uptake for cascade testing is
59:36beyond the 40% for family members to
59:39come forward do the testing for a
59:41bracket and not only the entity also
59:43to undergo prophylactic mastectomies
59:44and of rectums if tested Boston.
59:47So we have that already on 6000 patients.
59:49So we thought initially that might
59:51be a problem given the culture.
59:53That actually is not an issue at all,
59:54so uptake lately for bracket
59:56testing is extremely high.
60:00No city.
01:00:04Yeah. We have one last question.
01:00:14Do you have a Rapid City population?
01:00:18And the Jordanian? Original update
01:00:22so the question is about the
01:00:24National Cancer Registry.
01:00:25We have a debt and Jordanians and we have
01:00:27data and refugees and the answer is yes.
01:00:30So what the National Cancer Registry report
01:00:32on both the Jordanian and then Jordanians.
01:00:34There is the specific sections
01:00:36for non Jordanians and refugees to
01:00:38natural difference different city.
01:00:41Yes there's a big difference
01:00:42in the statistics city,
01:00:44the accessory for care and
01:00:46unfortunately the outcome also
01:00:48what the could be the reason.
01:00:50What the difference?
01:00:52The difference is the exposure and the one,
01:00:55therefore the difference in
01:00:56in rates for the outcome.
01:00:58Obviously lots of those refugees they
01:01:01had don't have the good accessory
01:01:04for sophisticated technologies,
01:01:06researchers and even treatment.
01:01:08Yeah, I was, I'm actually very impressed
01:01:11with the program you have made,
01:01:13but I also would like to remind you. Don't
01:01:16forget your tradition.
01:01:20That is actually may play important
01:01:22role in the future treatment of the
01:01:25any diseases we do, we will not read.
01:01:29This is a tradition that's being again
01:01:31in the country and it's probably
01:01:33the Arab board that to to extend
01:01:34the hands for for needed people.
01:01:38But thank you so much again
01:01:40for this great presentations.
01:01:42We have a couple of tokens of appreciations
01:01:44for you coming all the way to tell
01:01:46us about your success story that will
01:01:49be presented by Doctor Roy Herbst,
01:01:50the head of medical Oncology
01:01:52and Doctor Stephanie Helen,
01:01:53the head of Hematology.
01:01:54So let's start with our Royal
01:01:57Highness Princess Aida.
01:01:58Thank you so much again for
01:02:00coming to TNT's Ledger.
01:02:11No.